Therapeutic Consideration of Periappendiceal Abscess: an Evaluation of Non-surgical Treatment Followed by Minimally Invasive Interval Appendectomy

Abstract

Purpose: Periappendiceal abscess (PAA) is a severe complicated appendicitis with high morbidity. Non-surgical treatment followed by interval appendectomy (IA) is associated with lower complication rate compared with emergency surgery (ES) and minimally invasive surgery (MIS) can be done more often. The purpose of this study is to assess the incidence and factors predictive of complications of surgery for PAA and to evaluate the clinical effectiveness of IA as a treatment policy to increase MIS.Methods: Retrospectively, we reviewed 171 patients undergoing surgery for PAA between 2011 and 2016 at Ulsan University Hospital. The incidence and influence of different factors were assessed by univariate and multivariate analyses. Results:In 171 patients, 28 (16.4%) developed postoperative complications, which included; wound complications (7.6%), intra-abdominal abscess (4.1%) and ileus (2.9%). In both analyses, only ES was independently associated with postoperative complications; (Relative risk, 15.0; 95% Confidence interval, 2.4~92.5). Comparing the IA and ES groups revealed that operative time, complication rate, laparoscopic approach, postoperative hospitalization, postoperative antibiotic use and bowel resection rate were significantly different. The postoperative complication rate of patients with PAA in ES group was 28.7%, which was statistically higher than that of IA group (3.6%). Especially, MIS rate was more than 9-times greater in the IA group (98.8% vs. 10.3%, p<0.001). Although the IA group required additional hospitalization, there was no statistical difference between the two groups in total length of hospital stay. Conclusion:Morbidity was high for patients who had emergency surgery for PAA. ES was the only factor associated with postoperative morbidity. IA can reduce the postoperative complication rate and allowed MIS to be used more often as a useful treatment policy for PAA.

The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis

“…The incidence of interval appendectomy may be increased due to the increase in cases of complicated appendicitis resulting from delayed time from symptom onset to ER visit. According to previous studies, interval appendectomy was not inferior to the initial surgical approach in terms of reducing postoperative morbidity ( 16 , 32 ). Although the initial surgical approach was still preferred in South Korea, interval appendectomy increased as the proportion of complicated appendicitis cases increased during the pandemic.…”

“…Emergency appendectomy is the treatment of choice, but there is still debate about its suitability in this pandemic era because several articles have reported that non-surgical management, such as antibiotic therapy, is non-inferior to appendectomy ( 14 , 15 ). In addition, it has been reported that initial non-surgical management, such as antibiotics, with or without percutaneous drainage followed by interval appendectomy in complicated cases such as periappendiceal abscess is effective and reduces postoperative complications compared to immediate appendectomy ( 16 ). Moreover, a change in the main treatment strategy has been observed in some countries.…”

The Impact of the Coronavirus Disease - 19 Pandemic on the Treatment of Acute Appendicitis: Presentation, Outcomes, Strategies of Acute Appendicitis During Coronavirus Disease -19 Pandemic

“…The incidence of interval appendectomy may be increased due to the increase in cases of complicated appendicitis resulting from delayed time from symptom onset to ER visit. According to previous studies, interval appendectomy was not inferior to the initial surgical approach in terms of reducing postoperative morbidity [11,25]. Although the initial surgical approach was still preferred in South Korea, interval appendectomy increased as the proportion of complicated appendicitis cases increased during the pandemic.…”

“…Emergency appendectomy is the treatment of choice, but there is still debate about its suitability in this pandemic era because several articles have reported that nonsurgical management, such as antibiotic therapy, is non-inferior to appendectomy [9,10]. In addition, it has been reported that initial non-surgical management, such as antibiotics, with or without percutaneous drainage followed by interval appendectomy in complicated cases such as periappendiceal abscess is effective and reduces postoperative complications compared to immediate appendectomy [11]. Moreover, a change in the main treatment strategy has been observed in some countries.…”